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The fight against cancer does not start in the oncology ward. It starts much earlier – in the air we breathe.

Too often, we think of cancer prevention through the lens of individual behaviour. But prevention also depends on the environments in which we live, work and grow. The air we breathe every day is one of the most important determinants of our health.

In Europe, only three countries meet the WHO guidelines on clean air, while almost all urban Europeans (95%) are exposed to air pollution levels above recommended limits.

Recent UICC analysis of the latest evidence has found that air pollution poses health threats far beyond lung cancer. Long-term exposure to PM2.5 causes a 12% increase in overall cancer mortality, including 20% higher mortality from breast cancer, 14% from liver cancer and 12% from lung cancer.

Cancer prevention begins long before a diagnosis. It starts with the policies we adopt, the energy we use, the transport systems we build, and the quality of the air in our communities. Clean air is not only an environmental objective; it is one of the most powerful public health interventions available to us.

The good news? The evidence on how to address this is clear, and so is the way forward. Air pollution is a major but preventable driver of cancer; it’s well within our grasp to tackle it.

Achieving these gains will require a coordinated effort between policymakers, advocacy organisations and global health institutions such as the World Health Organization.

The revised European Union (EU) Ambient Air Quality Directive is a major opportunity for public health, because it brings stronger standards, stronger implementation requirements and stronger protections for citizens.

One of the most progressive air regulatory frameworks in the world, the Directive aligns EU standards closer to WHO guidelines and is expected to reduce over half of the premature deaths from air pollution in the EU.

The real test is no longer the adoption of the law, but its implementation. Member States must transpose the Directive by December 2026, and this creates a decisive window to ensure that ambition is maintained and that implementation is meaningful in practice, not only on paper.

The experience of cities across Europe demonstrates that progress is possible. Clean air is one of the rare public health interventions that delivers benefits almost immediately, while also creating healthier, more liveable and more equitable communities. Cities such as London, Paris and Milan are introducing low-emission zones, regions are taking action on domestic heating, and local leadership is showing that progress can happen even in politically or economically difficult contexts.

Just as importantly, we should not be deterred by backlash. Evidence from across Europe shows that these policies work when they are well designed, well communicated and socially fair. Most recently, for example, Imperial College researchers have found that emergency hospital admissions in London fell after the introduction of the T-charge and Ultra Low Emission Zone.

Policymakers can also do more to support a rapid transition to clean heating, improving residents’ health while easing the cost of living. Several European countries have shown that replacing outdated solid-fuel heating systems, supporting household energy efficiency, and providing targeted financial assistance to vulnerable families can reduce pollution while protecting households from rising energy costs.

There’s a huge opportunity to support cities and regional authorities to develop clean heating policies that are environmentally effective, socially acceptable and fair, with a strong focus on the households most at-risk from toxic air.

Policymakers must recognise that clean air is not simply an environmental objective. It is a health imperative. If we are serious about reducing the future burden of cancer and other chronic diseases, improving air quality must be recognised as one of the most effective, equitable and cost-efficient public health interventions available.

Health is the strongest argument for environmental action. Every reduction in pollution means fewer cancers, fewer hospital admissions, healthier children, and longer, healthier lives.

By acting on air pollution now, we can prevent cancers before they begin, improve survival for those diagnosed, reduce pressure on health systems, and create healthier societies for future generations. This is an opportunity we cannot afford to miss.